Method and apparatus for treating meibomian gland dysfunction

ABSTRACT

A method and apparatus for treating gland dysfunction caused by gland obstruction in order to restore the natural flow of secretion from the gland comprises the application of a combination of energy, suction, vibration, heat, aspiration, chemical agents and pharmacological agents to loosen and thereafter remove the obstructive material&#39;.

PRIORITY CLAIM

This invention claims priority from U.S. Provisional Patent ApplicationSer. No. 60/700,233 filed Jul. 18, 2005, which is incorporated herein byreference in its entirety and is hereby made a part of thisspecification.

FIELD OF THE INVENTION

This invention relates generally to the field of treatment of glands inorder to restore natural secretory function to obstructed glands withinthe body and specifically, the meibomian glands of the eye.

BACKGROUND OF THE INVENTION

The human body contains a number of glands including the lacrimal andmeibomian glands of the eye, the sebaceous or pilo-sebaceous hair glandson the face and underarms, and the mammary glands in the breasts. Theseglands may malfunction due to age, irritation, environmental conditions,cellular debris, inflammation, hormonal imbalance and other causes. Onecommon malfunction is the restriction or stoppage of the natural flow ofsecretions out of the gland. The present invention provides methods andmodalities to enhance and/or restore the natural flow of secretions outof the glands.

While the description that follows is directed to the meibomian glandsof the eye, it will be understood that the present invention may beemployed to treat all of the external glands of the body. Withparticular reference to the human eye, the tear film covering the ocularsurfaces is composed of three layers. The innermost layer in contactwith the ocular surface is the mucus layer. The middle layer comprisingthe bulk of the tear film is the aqueous layer, and the outermost layeris a thin (less than 250 nm) layer comprised of many lipids known as“meibum” or “sebum”. The sebum is secreted by the meibomian glands,enlarged specialized sebaceous-type glands (hence, the use of “sebum” todescribe the secretion) located on both the upper and lower eye lids,with orifices designed to discharge the lipid secretions onto the lidmargins, thus forming the lipid layer of the tear film. The typicalupper lid has approximately 25 meibomian glands and the lower lid hasapproximately 20 meibomian glands, which are somewhat larger than thoselocated in the upper lid. The meibomian gland comprises various sac-likeacini which discharge the secretion into the duct of the gland. Thesecretion then passes into the orifices which are surrounded by smoothmuscle tissue and the muscle of Riolan which are presumed to aid in theexpression of sebum. The meibomian gland orifices open on the lid marginusually along the mucocutaneous junction also known as the gray line.The meibomian gland orifices are assumed to open with blinking andrelease minute amounts of sebum secretions onto the lid margin and theninto the inferior tear meniscus. The lipid “sebum” in the tear meniscusis spread upward and over the tear film of the open eye by the upwardblink action. If the lipid secretions are optimal, and adequate lipidlayer is maintained at the air interface to minimize evaporation andprevent dry eye states. If the lipid secretions are inadequate the lipidlayer is not adequate to minimize evaporation with resulting rapidevaporation leading to dry eye states. Thus, it will be seen that adefective lipid layer or an incorrect quantity or quality of such lipidscan result in accelerated evaporation of the aqueous layer which, inturn, causes symptoms which may include symptoms such as dryness,scratching, irritation, burning, tearing, redness, and itchiness, whichare collectively be referred to as “dry eye” symptoms.

Dry eye states have many etiologies. A common cause of common dry eyestates is the condition known as “meibomian gland dysfunction”, adisorder where the glands are obstructed or occluded. As employed hereinthe terms “occluded” and “obstruction” as they relate to meibomian glanddysfunction are defined as partially or completely blocked or pluggedmeibomian glands. If completely obstructed the gland cannot secrete. Ifpartially or intermittently occluded the gland may secrete either normalor decreased amounts of sebum. More usually the secretions are alteredhaving semi-solid, thickened, congested secretions, frequently describedas inspissated. The secretions may be clear or yellowish, the latterindicating possible infection. Meibomitis, an inflammation of themeibomian glands leading to their dysfunction, is usually accompanied byblepharitis (inflammation of the lids). Meibomian gland dysfunction mayaccompany meibomitis, or meibomian gland dysfunction may be presentwithout obvious lid inflammation. Meibomian gland dysfunction isfrequently the result of keratotic obstruction of the individualmeibomian gland orifices and/or the central duct (canal) of the glandwhich compromises the secretory functions of the individual meibomianglands. More particularly, these keratotic obstructions include acombination of desquamated epitlelial cells, keratin, sebaceous groundsubstance, and bacteria, see, Korb et al., Meibomian Gland Dysfunctionand Contact Lens Intolerance, Journal of the Optometric Association,Vol. 51, Number 3, (1980), pp. 243-251. While meibomitis is obvious byinspection of the external lids, meibomian gland dysfunction may not beobvious even when examined with the magnification of the slit-lampbiomicroscope, since there may not be external signs or the externalsigns may be so minimal that they are overlooked. The external signs ofmeibomian gland dysfunction may be limited to subtle alterations of themeibomian gland orifices, subtle or pronounced overgrowth of epitheliumover the orifices, and pouting of the orifices of the glands withcongealed material acting as the obstructive material under theepithelia overgrowth resulting in the pouting of the orifices.

Hormonal changes include those which occur during menopause, andparticularly changing estrogen levels, can result in thickening of theoils secreted by the meibomian glands which results in clogged glandorifices. Further, decreased estrogen levels may also enhance conditionsunder which staphylococcal bacteria can proliferate. This can causemigration of the bacteria into the glands, thus resulting in a decreasedsecretion rate.

When the flow of secretions from the meibomian gland is restricted dueto the existence of an obstruction, epithelial cells on the eyelidmargin tend to grow over the gland orifice thus further restrictingsebum flow and exacerbating the dry eye condition.

Additional factors which may cause or exacerbate meibomian glanddysfunction include, age, contact lens wear and hygiene, disorders ofblinking, extended computer use, cosmetic use, or other illness,particularly diabetes.

Clinical evaluation of the meibomian glands requires the application ofpressure to the external surface of the eyelids over the meibomianglands in order to determine whether secretion is obtained from theindividual gland with gentle pressure. If gentle pressure does notprovide secretion, forceful expression may be utilized to determine ifsecretion can be obtained. Thus, the state of an individual meibomiangland can vary from optimal, where clear meibomian sebum is expressedwith gentle pressure; to mild or moderate meibomian gland dysfunctionwhere milky fluid or inspissated or creamy secretion may be obtained; tototal blockage where no secretion of any sort can be obtained even withthe application of extreme pressure (see Korb, et al., “Increase in TearFilm Lipid Layer Thickness Following Treatment of Meibomian GlandDysfunction”, Lacrimal Gland, tear Film, ad Dry Eye Syndromes, pp.293-298, Edited by D. A. Sullivan, Plenum Press, New York (1994)).Significant chemical changes of the meibomian gland secretions occurwith meibomian gland dysfunction and consequently, the composition ofthe naturally occurring tear film is altered, which in turn, contributesto ocular disease which is generally known as “dye eye”.

While the tear film operates as a singular entity and all of the layersthereof are important, the lipid layer, which is secreted from themeibomian glands is of particular significance as it functions to slowthe evaporation of the underlying layers and to lubricate the eyelidduring blinking which prevents dry eye.

In response to the foregoing, various treatment modalities have beendeveloped in order to treat the dry eye condition, including drops whichare intended to replicate and replace the natural tear film,pharmaceuticals which are intended to stimulate the gland and cellsproviding the components of the tear film and various warm compressesand warming devices which are designed to treat meibomitis and themeibomian glands.

Eye drops such as Refresh®, Soothe® and Systane® are designed to closelyreplicate the naturally occurring healthy tear film. However, their useand administration is merely a treatment of symptoms and not of theunderlying cause. Further, the use of drops is generally for anindefinite length of time and consequently, extended use can becomeburdensome and costly. Pharmaceutical modalities such as the use oftetracycline have also been suggested to treat meibomian glanddysfunction and one such treatment is disclosed in United States PatentPublication no. US2003/011426 titled “Method for Treating MeibomianGland Disease”, U.S. Pat. No. 6,455,583 titled “Method for TreatingMeibomian Gland Disease” to Pflugfelder et al. and PCT Publication No.WO 99/58131 titled “Use of Tetracyclines for Treating Meibomian GlandDisease”. However, this treatment has not proven to be clinicallyeffective for meibomian gland obstruction, and it may be unnecessary asmuch meibomian gland dysfunction is the result of an obstruction of thegland without infection. The use of corticosteroids have also beenproposed to treat meibomian gland dysfunction as disclosed in U.S. Pat.No. 6,153,607 titled “Non-preserved Topical Corticosteroid for Treatmentof Dry Eye, filamentary Keratitis, and Delayed Tear Clearance (orTurnover) to Pflugfelder et al. Again, this proposed treatment appearsto treat the symptom of dry eye, as opposed to treatment of theunderlying cause and further presents the risks of inducing cataractsand glaucoma. Additionally, the use of topically applied androgens orandrogen analogues have also been used to treat acute dry eye signs andsymptoms in Keratoconjuctivitis Sicca as disclosed in U.S. Pat. No.5,958,912 and U.S. Pat. No. 6,107,289 both titled “Ocular Therapy inKeratoconjunctivitis Sicca Using Topically Applied Androgens of TGF-β”and both issued to Sullivan.

Another modality for the treatment of meibomian gland dysfunction isdisclosed in European Patent Application serial no. PCT/GB2003/004782titled “Eyelid Margin Wipes Comprising Chemical Means for TemperatureAdjustment”. As disclosed in this patent application, an eyelid marginwipe is provided wherein prior to use, a chemical agent is activatedthat will heat the wipe to about 32° C. to about 55° C. and wherein thetemperature will be maintained for at least ten minutes to treat theeyelid margin. This method is not without its drawbacks in that lidirritation can be exacerbated by non-specific heating and the heatingrange noted as comfortable at over 50° C. would burn the skin. Anothermethod of heating the eyelids and meibomian glands uses near infraredradiation. More specifically, two hard eye patches were attached to aneye mask according to the pupillary distance of the subject. The eyemask was held in place by an elastic headband. Each patch employed 19light emitting diodes, emitting near infrared radiation from 850 nm to1050 nm, with a peak at 940 nm. The device produced 10 mW/cm² of energyoperating on electrical power. Goto, E., et al,. Treatment ofNon-Inflamed Obstructive Meibomian Gland dysfunction by an Infrared WarmCompression Device, British Journal of Ophthalmology, Vol. 86 (2002),pp. 1403-1407.

United States Patent Publication US2004/0237969 titled “Therapeutic Eyeand Eye Lid Cover” comprises a pair of goggles that are adapted todeliver humid saturated air around the eyelids. This modality is alsodiscussed in greater detail in the article titled “Tear Film Lipid LayerThickness and Ocular Comfort after Meibomian Therapy via Latent Heatwith a Novel Device in Normal Subjects by Mitra et al, published in Eye,(2004) at pages 1-4.

United States Patent Publication US2003/0233135 titled “Method andApparatus for Preventing and Treating Eyelid Problems” by Yee attemptsto clear the plugged meibomian glands by means of electrical stimulationof the muscle of Riolan which the invention presumed to aid in theexpression of the meibomian gland secretion.

It will be noted that all of the above-noted treatment modalities arenot without their inherent drawbacks and deficiencies. For example, thecurrent application of heat to the meibomian glands treatment is verytime consuming. Normally, treatment consists of at least fifteen minutesof heat application which is followed by manual expression, whichnormally consists of placing a cotton swab or firm surface behind theportion of the eye lid where the blocked meibomian gland is located andmanually squeezing the obstruction from the gland, the foregoing oftenbeing quite painful despite the use of topical anesthesia provided ineye drop form.

It is therefore an object of the present invention to provide ameibomian gland treatment that overcomes the drawbacks and deficienciesof the prior art.

Another object of the present invention is to provide a meibomian glandtreatment device that is a single step treatment, thus, eliminating theneed for manual expression.

Yet another object of the present invention is to provide a meibomiangland treatment device which treats meibomian gland disease and notmerely its symptoms.

Still another object of the present invention is to provide a meibomiangland treatment device that restores the natural sebum flow rather thanmerely attempting to replace or replicate the naturally occurring tearcomponents.

A still further object of the present invention is to provide ameibomian gland treatment device which minimizes the chance ofinfection.

A still further object of the present invention is to provide ameibomian gland treatment device that is simple, inexpensive, and easyto use by the health care provider and the patient.

SUMMARY OF THE INVENTION

According to the present invention there is provided a method andapparatus for treating meibomian gland dysfunction wherein the flow ofnaturally occurring secretions from the meibomian gland is restored. Themethod comprises applying a regulated force, regulated energy, regulatedheat and/or chemical/pharmacological agent or combinations thereof tothe eyelid to remove obstruction in order to restore the natural flow ofsecretion from the meibomian gland. In further aspects of the invention,the obstruction may be dissolved, extracted and/or loosened from thegland wall, softened prior to extraction and/or expansion of the glandorifice or channel such that the normal secretions from the gland arerestored. In other aspects of the invention the obstruction may beloosened from the gland wall or softened prior to extraction.Additionally, the force applied to loosen the obstruction may be of apre-selected magnitude and applied for a pre-selected period of time.

The apparatus comprises means for applying an external or internalforce, energy or heat (or a combination of the foregoing) to the glandto loosen the obstruction. Further aspects of the invention includeproviding means for softening, breaking up, and/or liquefying theobstruction prior to extraction and means for extracting theobstruction.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic cut away view of the upper and lower eyelidsillustrating the meibomian glands in cross section.

FIG. 2 is a cross sectional view of a single meibomian gland.

FIG. 3 a is a perspective view of a system for clearing obstructedmeibomian glands.

FIG. 3 b is a broken away side view of the probe tip employed in theembodiment of FIG. 3 a.

FIG. 4 a is a perspective view of a second embodiment of the probe tipaccording to the present invention.

FIG. 4 b is a broken away side view of the probe tip of FIG. 4 a.

FIG. 4 c is a broken away side view of the probe tip of FIGS. 3 a and 4a in place on an eye lid.

FIG. 5 is broken away side view of an alternate for clearing obstructedmeibomian glands according to the present invention.

FIG. 6 a is a side view of an alternate embodiment of the probe tiphaving rollers for clearing obstructed meibomian glands according to thepresent invention.

FIG. 6 b is a side view of another alternate embodiment of the probe tiphaving rollers for clearing obstructed meibomian glands according to thepresent invention.

FIG. 7 is a side view of another alternate embodiment of the probe tiphaving rollers for clearing obstructed meibomian glands according to thepresent invention.

FIG. 8 is a perspective view of a suction device for clearing glandsaccording to the present invention.

FIG. 9 is a side view of another embodiment of the apparatus forclearing meibomian glands according to the present invention.

FIG. 10 a is a schematic view of another embodiment of the apparatus forclearing meibomian glands according to the present invention.

FIG. 10 b is an exploded view of the hand-held probe of the embodimentof FIG. 10 a.

FIG. 10 c is a side view of the hand-held probe of FIGS. 10 a and 10 bapplying force to an eyelid.

FIG. 11 a is a perspective view of another embodiment of the meibomiangland treatment apparatus in the form of the hydro-oculator according tothe present invention.

FIG. 11 b is a side view of the hydro-oculator of FIG. 11 a.

FIG. 11 c is a schematic side view of the hydro-oculator according tothe present invention in place against the lower eyelid.

FIG. 11 d is a schematic side view of the hydro-oculator according tothe present invention in place against the lower eyelid and showing thefluid filled bladder beginning to expand.

FIG. 11 e is a schematic side view of the hydro-oculator according tothe present invention in place against the lower eyelid and showing thefluid filled bladder in a further expanded state.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

While the present invention will be described more fully hereinafter, itis to be understood at the outset that persons of skill in the art maymodify the invention herein described while still achieving thefavorable results of this invention. Accordingly, the description thatfollows is to be understood as a broad teaching disclosure directed topersons of skill in the appropriate arts, and not as limiting upon thepresent invention.

Referring now to FIG. 1, the location of the meibomian glands M areshown on the upper and lower eyelids. As briefly stated herein above,the upper lid contains approximately 25 meibomian glands and the lowerlid contains approximately 20 meibomian glands. As shown in FIG. 2, eachgland includes a channel C into which the secretion flows and an orificeO which opens on to the eyelid margin and through which the secretionmust flow in order to be added to the tear film upon blinking. It willbe seen that the glands are of different size, depending upon thelocation in the eyelid and that the orifice O is narrower than thechannel C.

As briefly mentioned herein above, obstruction composition will varywith the etiology which produced it. However, the obstruction will, inmost cases, consist of a combination of, dead cells, keratin, bacteria,desquamated cells, sebaceous ground substance, milky fluid, inspissatedor creamy secretions, or any combination of the foregoing in solid,semi-solid and thickened forms. The obstruction may be in the glandchannel, at the gland orifice, atop the gland orifice or a combinationof the foregoing. As employed herein, obstruction refers to any of theforegoing.

Thus, it is self-evident that any obstruction of the channel willrestrict or prevent secretions from exiting the gland and further, thatin order to clear such obstructions or “occlusions”, the obstruction maybe loosened from the gland wall, and/or broken up, fractured, softened,or liquified so that it will fit through the gland orifice withoutcausing excessive pain. Lastly, the obstruction remnants must beexpressed from the gland. The present invention provides a method andapparatus to accomplish these tasks.

According to the method of the present invention, the obstruction Pshould be softened or liquefied prior to attempting extraction orexpression. With respect to the foregoing, the terms “softened” or“liqified” are intended to mean a “non-solid” flowable state. Inaddition, in order to be clinically satisfactory, softening orliquefying of the obstruction P should be effected as quickly aspossible and regulated heat treatment time should be less than five (5)minutes with one to two (1-2) minutes being preferred without causingdamage to the surrounding tissues of the ocular globe or the eye, suchheat treatments can be electrical, laser heating, hot water conductiveheating, infrared heating, ultrasonic heating, RF heating, etc. Thisnecessarily requires the addition of a greater amount of energy(heating) than is deliverable by the conventional application of hotcompresses which according to current practice are applied for 3-15minutes prior to the clinician attempting to remove the obstruction.Once the obstruction is softened or liquified, removal is obtained bythe application of a regulated force to the gland. More specifically, itis contemplated by the present invention that the force applied be arepeatable controlled force, as more fully explained herein below.

Treatment to remove the obstruction will involve the application of anexternal regulated force to the eyelid and/or directly over theobstructed orifice to loosen the obstruction within the gland G and theorifice. The means for applying the force may be selected from one ormore of a number of modalities wherein the frequency of vibration may beincluding low frequency vibration (generally less than 1000 Hz), sonic(generally 1000 Hz to 20,000 Hz) or ultrasonic energy (generally greaterthan 20,000 Hz), fluid jet such as air or water, microwave energy,needles, micro-needles, laser energy, RF energy, aspiration/suction,vacuum, pressure, compression and functional equivalents thereof. Inaddition, once a modality is chosen, the physician will have todetermine the optimum treatment parameters so that each of the foregoingmodalities will be applied to the eyelid such that the force (or energy,as appropriate) provided thereby is transmitted through the eyelidtissue to the obstruction. Further, the treatment intensity and lengthof application of these external forces will vary with the size andcomposition of the obstruction. Once a treatment protocol isestablished, the force can either be set or variable within apreselected range. Experiments were performed using an eccentricvibrating motor applied directly to the human eyelids. Bench tests ofthe vibration revealed the following data points, specifically settingnumber 3 was shown to be clinically effective to loosen the obstructionwithin the meibomian gland and orifice: Setting Vibration Freq. (Hz.)Vibration Amplitude (in/μm) 1 51 .001 in. (25.4 μm) 2 118 .004 in. (100μm) 3 165.5 .0062 in.(157.5 μm)

Once the obstruction has been loosened from the walls of the gland, itmay be operated upon such that it will pass through the orifice O in amanner which causes little or no pain or discomfort to the patent. Thiscan be accomplished by heating to soften or liquify the obstruction upto a range of thirty seven degrees centigrade (37° C.) to fifty degreescentigrade (50° C.) with the preferred operating range being fortydegrees centigrade (40° C.) to forty seven degrees centigrade (47° C.)and desired modality of forty two degrees centigrade (42° C.) to fortysix degrees centigrade (46° C.) so that it easily passes through theorifice (or with minimal non-painful expansion thereof). Modalities forheating may include conduction, convection and radiation supplied by oneor more of the following: thermal conduction, thermal convection,ultrasonic energy, laser energy, RF energy, direct and/or indirecttransfer from heat source ad microwave energy which may be applied for apreselected period of time. By varying the amplitude, intensity andlength of application, some of the foregoing modalities may also beemployed to fracture or break up the obstruction. It will be noted thata closed loop feedback control system, well known to those skilled inthe art (not shown) may be employed during heating to measuretemperature proximate the eyelid to ensure that the obstruction does, infact, reach a temperature sufficient to turn the obstructive materialinto a flowable, liquid or semi-liquid state.

Extraction of the softened, broken apart or fractured obstruction may beaccomplished by one or more of the following: needles, micro-needles,aspiration/suction, vacuum, pressure and compression. One embodiment ofthe invention is a suction system that is placed over the gland orificemay be employed to suck out the components of the softened, loosened orliquefied obstruction or the pieces thereof, as appropriate oralternatively, to employ suction to collect the obstruction as it exitsthe gland orifice. In order to be clinically effective, the foregoingmodalities for extracting or expressing the obstruction should beadministered in a fashion that is regulated, i.e., done in a repeatablemanner.

An apparatus for unplugging the obstructed gland channel C isschematically illustrated in FIG. 3 a. The apparatus comprises a powersource 100 which may be direct current (battery powered) or alternatingcurrent (wall socket) as desired. The power source 100 is connected to acontroller, generally indicated at 200, which includes a power on/poweroff switch 210. The controller 200 includes a means 220 for applying anexternal force to the gland to loosen the obstruction. The means 220includes a probe 230, which is adapted to vibrate at a preselectedfrequency at preselected amplitude. The probe 230 may vibrate at sonicor ultrasonic frequencies as needed. In addition, means for varying thefrequency 240 and amplitude 250 of the probe output, well known to thoseskilled in the art, are provided. The means 220 for applying theregulated external force or regulated energy to the obstruction may alsoinclude fluid jet, air fluid, water fluid, microwave energy, needles,micro-needles, laser energy, RF energy, aspiration, suction, vacuum,pressure, piezoelectric, and compression.

Turning now to FIG. 3B, a small ultrasonic probe 230 (and specificallythe probe tip) is illustrated in FIG. 4C in place on the eyelid. Theprobe 230 is adapted to deliver ultrasonic vibrational energy throughthe skin into the obstruction P in order to loosen, liquefy, and/orfracture the obstruction. More specifically, by tuning the probe outputso that the obstruction P resonates (by adjusting the frequency andamplitude of the signal) energy is efficiently transferred to theobstruction and sympathetic vibration of the obstruction P occurs withminimal energy transfer to the surrounding tissues. In some instances,vibration alone may be sufficient to change the characteristics of theobstruction P such that vigorous blinking may express the obstructionremnants.

In addition to vibration alternative force, energy, aspiration and/orchemical/pharmacological agents can be used to open up the channel C.The probe may be further equipped with aspiration means 260 (bestillustrated in FIG. 4C for introducing aspiration, suction or vacuuminto the gland channel C to evacuate the obstruction remnants.Alternatively, heat and aspiration may be employed in lieu of or inaddition vibration.

In another aspect of the invention, the probe 230 may be equipped with ameans for heating 270 such as a solid state heating element which may beregulated to provide relatively precise amounts of energy in thepreviously mentioned ranges that assists in softening, liquifying ormelting the obstruction P via heat transfer through the tissue when theprobe is placed against the tissue.

A second embodiment of the invention (FIG. 5) employs microdermabraisionor exfoliation to remove any cells or cellular material that may haveovergrown the gland opening. Microdermabraision is a process that wasdeveloped for use in dermatology to remove dead skin cells. As shown inFIG. 5 a probe or tip 330 is equipped with an abrasive surface 310 thatis adapted to scrape the skin. The abrasive employed is usually adiamond power or other suitable material, well known to those skilled inthe art. An inner tube 320 having a central bore 325 includes holesdefining openings 330 through which a fluid such as air is pumped. Anouter covering 335 surrounds the tube 320, but at its lower edge extendsslightly lower and is spaced from the abrasive surface 310 and a spaceis defined between the lower ends of the respective tubes 320, 335. Theouter covering is connected to aspiration, vacuum, and/or suction thatoperates as described herein below.

In operation, the clinician would place the abrasive tip 310 in contactover the gland orifice creating a seal between the tip and the skin.Movement of the probe 330 would cause the abrasive 310 on the bottom ofthe tip to separate the cells from the skin and the aspiration, suctionor vacuum would extract the cellular material from the vicinity of thegland opening. In addition, depending upon the obstruction, aspiration,suction and/or vacuum alone may be sufficient to extract theobstruction.

Additional features may also be providing to the microdermabraision tipsuch as a heating element 340 which could be placed in the outercovering 335 near the tip. In addition, the inner tube 320 could beequipped such that ultrasonic energy could be delivered to theobstruction as discussed herein above.

Another embodiment of the invention may employ a chemical agent to cleanthe gland margin and to remove or exfoliate cells from the meibomiangland orifice. For example Ophthaine® or a similar pharmacological agentmay be employed to assist in removing epithelial cells from over thegland orifice. A probe similar to that shown in FIG. 5 may be employed,except that the inner tube will deliver the chemical agent and thesuction applied by the outer covering will be used to evacuate the usedchemical agent and cellular material mixture away from the gland margin.Similarly, the heating and vibrational features discussed above may alsobe included.

A further embodiment of the invention may deliver vibrational and/orthermal energy to the obstruction P without contacting the gland. Onepotential energy source is laser light supplied by titanium, argon,krypton or microwave energy. Extraction of the obstruction would beaccomplished by the means described herein above.

A third embodiment of the invention employs pressure applied to thetissue as shown in FIGS. 6 a, 6 b and 7 by rollers (or drums) 375 whichare placed in front of and/or behind the meibomian gland with therollers applying constant regulated pressure to the meibomian glands toapply a “milking” type force to expel the obstruction to return thegland to normal secretion levels. The rollers can be connected to heat,aspiration, vacuum, and/or suction that operate as described herein.

In operation, the physician would place the rollers 375 in contact withthe eyelid, either inside, outside or both. Lateral movement of therollers 375 would cause pressure to be applied to the gland to removethe obstruction. Alternatively, aspiration, suction and/or vacuum couldbe applied to extract the obstruction and material from the vicinity ofthe gland opening. In addition, depending upon the obstruction,aspiration, suction and/or vacuum alone may be sufficient to extract theobstruction.

Additional features may also be provided to the rollers such as aregulated heating element (not shown) which could be placed in the outercovering near the tip as shown in FIG. 6A. In addition, the roller 375could be equipped such that ultrasonic energy could be delivered to theobstruction as discussed herein above.

FIG. 8 illustrates a prototype hand held suction system generallyindicated at 400 that was constructed. The system comprised an AC powersupply 410 which powered a suction pump 420 to which tubing 430 wasconnected. At the opposite end of tubing 430 a probe 440 was connected.A tip 450 having a 1 mm diameter and a 200 micron orifice was attachedto the end of the probe 440. The probe end 460 was curved for ergonomicaccess to the gland orifice. In use, the tip 450 is placed on orproximate the gland orifice and the applied vacuum is used to collectthe obstruction as it exits the orifice or may alternatively be employedto assist in expression of the obstruction.

FIG. 9 illustrates another prototype of a hand held apparatus generallyindicated at 500 that was constructed. The system comprised a powersupply 510 which powered an electromagnet (not shown) which was encasedin a handle 530 that may be easily held by the clinician in one hand. Arod 540 is mounted for reciprocating motion to the output of theelectromagnet. The throw or amount of movement of the rod 540 is 0.5 mm.At the end of rod 540 is mounted a back plate 550 which is substantiallyperpendicular to the axis of rod 540. Further, a lever 560 is pivotallymounted to rod 540 and operates to actuate a roller 570. A heating meansor heater 580 was mounted in backplate 550. The heater 580 was alsoprovided with an appropriate power source. In operation, the device ispositioned such that the back plate 550 is positioned between the corneaand the back surface of the eye lid. The lever 560 is actuated such thatthe roller 570 comes into contact with the front surface of the eye lid.The arc of the roller is such that the eye lid is squeezed between theforegoing The clinician may elect to maintain the back plate and theroller under tension for a preselected period of time to soften theobstruction. Once the desired temperature has been reached, furtherpressure on the lever 560 will cause the roller to move from the bottomof the meibomian gland (the end away from the orifice) to the top of thegland to express the obstruction from the gland in am “milking type”motion. Thus, a repeatable regulated method for opening obstructedmeibomian glands is provided.

The embodiment illustrated in FIGS. 10A through 10C, the presentinvention prototype is a hand held apparatus generally indicated at 600.The apparatus comprises a power source 610 which may be a DC source suchas a battery or an AC source similar to those discussed herein above.The power source 610 resides within a housing 620. The power source 610provides electrical current to a wave form generator 625 which powers anacoustic amplifier 630 (for example, a small audio speaker) also locatedwithin housing 620 and mounted at an ergonomic angle therein. Theacoustic amplifier 630 is programmed to vibrate in a wave format at afrequency of 0 to 200 Hz at an amplitude in the range of 0.25 mm to 5mm. Initial experiments indicate that free air amplitude of 3-4 mm at afrequency of 60 Hz to 125 Hz is well tolerated and after 10-30 secondsof application seems to impart a natural numbing effect to theeyelid/gland. Mounted in operative association atop the acousticamplifier 630 is an annulus 635 that floats thereon and includes a coneshaped housing 640 extending perpendicularly away from the amplifier 625that encloses the amplifier 625 The end of the housing 640 is adapted tomount a variety of tips 650. For example, the tip may comprise a roller655 mounted for rotation in a cradle 665. Further, the tip 650 may bemodified to include a regulated heating element (not shown) that acts tosoften the obstruction. Other tip configurations may include a vacuumfor collecting the obstruction after expression thereof from the glandand different tip configurations to apply various contact areas andresulting forces. Thus, it will be seen that the obstruction is actuallysubjected to a pair of forces, the first being the weight of the deviceitself on the gland which may be combined with additional pressure bythe health care provider pressing on the gland plus the additionalintermittent force delivered to the gland by the vibratory or pulsatoryforce of the tip 650. The first force may be a fixed constantly appliedforce or one that increases to a preselected maximum. Testing hasindicated that use of the foregoing method, i.e., applying a first forceto the meibomian gland and a second pulsatile force to the meibomiangland allows delivery of a greater quantity of energy to the obstructionwhile lowering the perceived pain level to the patient. It is believedthat this is the result of an overall lower degree of localized nervestimulation about the orbit. Heating the gland is also beneficial in theevent softening of the obstruction is needed prior to expressionthereof.

Another embodiment of the invention is shown in FIGS. 11A through 11Ewherein the treatment apparatus is incorporated into a goggle-likedevice, termed herein as the “hydro-oculator” which is a head bornedevice that locates the treatment mechanism proximate the eyelids,generally indicated at 700. The hydro-oculator 700 comprises a flexibleframe 705 having a headband 710 (which may be elastic) connected theretoat each end. Connected to the bottom of the frame 705 is a moldedhousing 720 which has an angled leg 725 which is adapted to overlie thecheek bone when the apparatus is in use. Further, an expandable fluid orgas impermeable container referred to herein as a bladder 730 ispositioned within the cavity defined by the space between the housingand the lower eye lid. A pumping mechanism is provided that facilitatesmovement of a fluid or gas, collectively referred to herein as a“medium” (not shown) into and out of each of the respective bladders730. According to the invention, the patient would position thehydo-oclulator 700 on his or her head such that the leg 725 of moldedhousing 730 rests on the upper cheek bone as best shown in FIGS. 11Cthrough 11E. The regulated heated medium is pumped into the bladders 730causing partial expansion thereof in order to apply a pressure to theeyelids in the range of from zero to fifty pounds per square inch (50psi). The bladder containing the heated medium (a water based solutionbeing preferred) is positioned on the eyelids over the meibomian glandsfor a preselected period of time (up to thirty minutes) to soften theobstruction. It is desirable to place the heat source in direct contactwith the eyelids which thereby transmits thermal energy to the meibomianglands, in contrast to the prior art which heats a confined space infront of the open eye where heat could be transmitted to the ocularbulbi structures such as the crystalline lens which introduces thepossibility of cataract formation. Thereafter, the bladder is slowlyexpanded to a preselected maximum such that the force on the glandincreases from the bottom up to the top or orifice end of the gland suchthat the obstruction is expressed therefrom in a “milking” type ofaction. Milking may be applied at a preselected frequency between zeroand five hertz (0-5 Hz) and for a preselected period of time, usuallynot more than thirty minutes. In addition, the medium may be “pulsed”,i.e., milkingly moved into and out of the bladder to further facilitateexpression of the obstruction from the gland. Pulsing may also beachieved by providing an external force to the bladder and transmittingthe force through the fluid into the gland. Pulsing may be applied at apreselected frequency between zero and one hundred hertz (0-100 Hz) fora preselected period time, usually not more than thirty (30) minutes. Achemical or pharmacological agent may be inserted into the meibomiangland to assist in softening the obstruction and any of the extractionmodalities mentioned above may be further employed to assist in removingthe obstruction.

Another embodiment of the invention may employ a chemical agent orcompound to clean the glandular margin to remove or exfoliate cells fromthe gland orifice. A probe similar to that shown in FIG. 5 may beemployed, except that the outer drum or roller will deliver the chemicalagent and the suction applied by the outer covering will be used toevacuate the used chemical agent and cellular material mixture away fromthe gland margin. Similarly, the heating and vibrational featuresdiscussed above may also be included.

A further embodiment of the invention may deliver vibrational and/orthermal energy to the obstruction P without contacting the gland. Onepotential energy source is laser light supplied by a titanium-sapphire,argon, krypton, RF energy or microwave energy. Extraction of theobstruction would be accomplished by the means described herein above.

Another embodiment of the invention employs the use of chemical orpharmacological agents to open or dilate the gland and gland orificewherein the obstruction naturally is expressed and returns the normalsecretions of the gland. Alternatively, the chemical or pharmaceuticalagent would be used to soften or breakup the obstruction with suchobstruction being expressed with the use of devices as defined above orcombinations thereof. Chemical or pharmacological agents may also beused in connection with the device for post treatment. Once the glandshave been opened then chemical or pharmacological agents may be used toenhance the normal production or secretion to maintain the glands in itsunblocked state.

Dilation of the meibomian gland channel and orifice may also be employedto loosen or free the obstruction from the gland walls. Dilation may beaccomplished by chemical, pharmacological, or mechanical means.

Stimulation of the meibomian gland may also be employed in conjunctionwith the other modalities discussed above to loosen or fracture theobstruction.

As mentioned herein above, the present invention has been described indetail on conjunction with the figures in connection with the meibomianglands of the eye. The reader will note that the principals of thisinvention may be applied with equal efficacy to the other glands of thehuman body and potentially to valuable domesticated farm animals totreat various ailments.

1. A method of treating dry eye in humans wherein the flow of naturallyoccurring secretion to the eye is occluded due to the presence of anobstruction of the meibomian gland of the eye lid and comprising thesteps of: lifting the eyelid away from the eye; softening theobstruction; and applying a regulated force to the eyelid.
 2. The methodaccording to claim 1 wherein the regulated force has an energy sourcecoupled to the eyelid surface for milkingly compressing the eyelid toexpress obstructive material from the meibomian gland.
 3. The methodaccording to claim 2 wherein the eyelid is positioned between a couplingsurface and a motion transmitting surface such that upon application ofthe regulated force to the eyelid, obstructive material is expressedfrom the meibomian gland.
 4. The method according to claim 1 wherein thestep of softening comprises the application of thermal energy to theobstruction.
 5. The method according to claim 4 wherein the thermalenergy applied is selected from the group of heat generating modalitiesconsisting of conduction, convection and radiation.
 6. The methodaccording to claim 1 wherein the step of heating further includesheating the obstruction to between about 37° C. to about 47° C.
 7. Themethod according to claim 2 wherein the energy source coupled to theeyelid surface for milkingly compressing the eyelid to expressobstructive material the meibomian gland comprises a roller.
 8. Themethod according to claim 3 wherein the coupling surface and the motiontransmitting surface are adjustable relative to each other to vary thepressure on the eye lid such that upon application of the regulatedforce to the eyelid, obstructive material is expressed from themeibomian gland.
 9. The method according to claim 1 wherein the step ofapplying a regulated force to the eyelid is performed with a hand helddevice.
 10. A method of treating dry eye in humans wherein the flow ofnaturally occurring secretion to the eye is occluded due to the presenceof an obstruction in the meibomian gland in the eyelid and comprisingthe steps of: lifting the eyelid away from the eye; softening theobstruction through the application of thermal energy to heat theobstruction to a temperature sufficient to turn the obstruction from asolid to a flowable state; and applying a regulated force to the eyelid.11. The method according to claim 10 wherein the obstruction is heatedto a temperature of between about 42° C. and about 46° C.
 12. The methodaccording to claim 10 wherein the regulated force has an energy sourcecoupled to the eyelid surface for milkingly compressing the eyelid toexpress obstructive material the meibomian gland.
 13. The methodaccording to claim 11 wherein the eyelid is positioned between acoupling surface and a motion transmitting surface such that uponapplication of the regulated force to the eyelid, obstructive materialis expressed from the meibomian gland.
 14. The method according to claim11 wherein the thermal energy applied is selected from the group of heatgenerating modalities consisting of conduction, convection andradiation.
 15. The method according to claim 13 wherein the couplingsurface and the motion transmitting surface are adjustable relative toeach other to vary the pressure on the eye lid such that uponapplication of the regulated force to the eyelid, obstructive materialis expressed from the meibomian gland.
 16. The method according to claim15 wherein the step of applying a regulated force to the eyelid isperformed with a hand held device.
 17. The method according to claim 1wherein the regulated force comprises a first adjustable constant forceand a second pulsatile force.
 18. The method according to claim 11further including the step of applying a pharmacological agent to thegland.
 19. The method according to claim 11 further including the stepof applying vacuum to extract the obstructive material from themeibomian gland.
 20. A method of treating dry eye in humans wherein theflow of naturally occurring secretion to the eye is occluded due to thepresence of an obstruction in the meibomian gland in the eyelid andcomprising the steps of: lifting the eyelid away from the eye; softeningthe obstruction through the application of thermal energy to heat theobstruction to a temperature of between about 42° C. and about 46° C.;and gripping the eyelid between a coupling surface and a motiontransmitting surface such that upon application of the regulated forceto the eyelid, the softened obstruction is expressed from the meibomiangland.
 21. The method according to claim 19 wherein the motiontransmitting surface includes a roller for milkingly massaging the glandto express the obstructive material from the meibomian gland.
 22. Amethod of treating dry eye in humans wherein the flow of naturallyoccurring secretion to the eye is occluded due to the presence of anobstruction in the meibomian gland in the eyelid and comprising thesteps of: coupling the eyelid; softening the obstruction with regulatedheat; and applying a regulated force and heat to the eyelid.
 23. Themethod according to claim 22 wherein the coupled regulated energy forceapplied to the eyelid surface milkingly compresses the eyelid to expressobstructive material from the meibomian gland.
 24. The method accordingto claim 22 wherein the regulated heat energy applied is selected fromthe heat generating modalities consisting of conduction, convection andradiation.
 25. The method according to claim 22 wherein the regulatedheat energy is maintained by a temperature measurement and feedbackcontrol loop
 26. The method according to claim 22 wherein the step ofheating further includes heating the obstruction to between about ofbetween about 37° C. and about 47° C.
 27. An apparatus for treating dryeye in humans wherein the flow of naturally occurring secretion to theeye is occluded due to the presence of an obstruction in the meibomiangland in the eyelid and comprising: means for coupling to the eyelid;regulated heating means for softening the obstructive material throughthe application of thermal energy to heat the obstruction to atemperature of between about 42° C. and about 46° C.; and gripping meansfor gripping the eyelid between a coupling surface and a motiontransmitting surface such that upon application of the regulated forceto the eyelid, obstructive material is expressed from the meibomiangland.